Contract Pharmacy Details

OUR LADY OF THE ANGELS OUTPATIENT PHARMA
RWIID70112 STD/HIV Program

Covered Entity Details

Entity Name

STD/HIV Program

Subdivision Name

OFFICE OF PUBLIC HEALTH

Type

Ryan White Part B ADAP Direct Purchase

340B ID

RWIID70112

Entity Address

1450 POYDRAS ST.
Suite 2136
NEW ORLEANS, LA 70112

Grant Number

X07HA00018

Participating Start Date

7/1/1998

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

OUR LADY OF THE ANGELS OUTPATIENT PHARMA

Pharmacy Address

433 PLAZA ST RM 311
BOGALUSA, LA 70427-3729

Pharmacy Comments

Contract Details

Approval Date

7/22/2014

Contract Begin Date

7/24/2014

Carve-In Effective Date

Contract Comments

07/24/2014 Immediate begin date authorizied

Contract Termination Date
Termination Reason

4/24/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

HEATHER WEAVER, TAB COORDINATOR
(504) 568-5489

Contract Pharmacy Representative

Tammy Belleau, Director of Pharmacy
(985) 730-6789

Signed By Date

7/22/2014

340B Drug Pricing Program Database